他克莫司联合糖皮质激素治疗Vogt-小柳原田综合征17例  

Effect of Tacrolimus Combined with Glucocorticoid in the Treatment of 17 Cases of Vogt-Koyanagi Harada Syndrome

作　　者：马培茹 杨华静 刘羊钰 李水 陈建斌 MA Peiru;YANG Huajing;LIU Yangyu;LI Shui;CHEN Jianbin(Department of Ophthalmology,Tongji Hospital,Tongji Medicine College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院眼科,武汉430030

出　　处：《医药导报》2022年第4期478-483,共6页Herald of Medicine

基　　金：湖北省自然科学基金资助项目(2012FKB02444);湖北省自然科学基金委员会面上项目资助项目(2018CFB463)。

摘　　要：目的探讨他克莫司(TAC)联合糖皮质激素(GC)治疗Vogt-小柳原田(VKH)综合征的临床疗效和安全性。方法回顾性分析2019年1月至2021年4月在华中科技大学同济医学院附属同济医院眼科首诊17例(33只眼)VKH综合征患者的临床资料。其中女8例,男9例,1例为单眼,16例双眼,平均年龄为(42.65±3.83)岁。所有患者入院后均予以口服TAC联合静脉用GC治疗,GC初始剂量为1.5~2.5 mg·kg^(-1)·d^(-1),减量至40~60 mg·d^(-1)后改为口服用药,后逐渐减量至停药,并适度缩短GC总使用时长;TAC初始剂量为2 mg·d^(-1),定期监测血药浓度,调整用药剂量使TAC血药谷浓度维持在5~10 ng·mL^(-1),且随访时间≥6个月。主要观察指标为视力、眼前节和眼后节炎症、GC使用时间及OCT所示黄斑区视网膜水肿或脱离程度。结果与治疗前相比,治疗6个月时,患眼视力明显提高(0.22±0.08 vs.1.06±0.03,P<0.01);治疗3个月时,角膜后沉积物(KP)、前房闪辉、视盘充血水肿、视网膜水肿/渗出性脱离阳性的患眼vs.例较治疗前已明显降低(9.09%vs.48.88%、15.15%vs.69.7%、0.00%vs.51.2%、3.33%vs.78.79%,P<0.01);治疗6个月时,发生黄斑区视网膜神经上皮层广泛或多发局灶性脱离、黄斑区部分神经上皮层脱离的患眼比例较治疗前也显著降低(0.00%vs.66.67%、9.09%vs.33.33%,P<0.01)。治疗期间,所有患者肝肾功能指标与治疗前相比无临床意义。结论使用他克莫司联合激素治疗首次就诊的VKH综合征患者是一种有效且安全的选择,可作为VKH综合征的一线治疗方法。Objective To assess the clinical efficacy and safety of tacrolimus(TAC)combined with glucocorticoid(GC)in the treatment of Vogt-Koyanagi Harada(VKH)syndrome.Methods The clinical data of 17 VKH patients(33 eyes)who were first diagnosed in Tongji Hospital,Tongji Medicine College,Huazhong University of Science and Technology from January 2019 to April 2021 were retrospectively analyzed.There were 8 females and 9 males,and among them,one case had 1 eye,and the rest had both eyes.The average age was(42.65±3.83)years old.All the patients were treated with oral TAC combined with intravenous GC after the admission.The initial dose of the GC was 1.5-2.5 mg·kg^(-1)·d^(-1),then was gradually reduced to 40-60 mg·d^(-1).After switching to oral administration,the dose was gradually reduced until stopped,and the total duration of GC was moderately shortened.The initial dose of TAC was 2 mg·d^(-1),and the blood concentration was regularly monitored.The dosage was adjusted to maintain the valley blood concentration of TAC at 5-10 ng·mL^(-1) and the follow-up time was at least 6 months.Main outcome indicators were visual acuity,inflammation of the anterior and posterior segments,GC use time,and the degree of retinal edema or detachment in the macular area as shown by the optical coherence tomography(OCT).Results Compared with the pre-treatment,the visual acuity in affected eyes were significantly improved after 6 months of treatment using TAC combined with GC(0.22±0.08 vs.1.06±0.03,P<0.01);After 3 months of combination treatment,the proportions of eyes with corneal(keratic precipitates,KP),anterior chamber flash,optic disc hyperemia and edema,and retinal edema/exudative detachment were decreased(9.09%vs.48.88%,15.15%vs.69.7%,0.00%vs.51.2%,3.33%vs.78.79%,P<0.01);After 6 months of combination treatment,the proportions of eyes with extensive or multiple focal detachment of the retinal neuroepithelial layer and partial neuroepithelial detachment in the macular area were significantly reduced(0.00%vs.66.67%,9.09%vs.33.33%,P<0.0

关 键 词：他克莫司 糖皮质激素 Vogt-小柳原田综合症 临床疗效 

分 类 号：R988.1[医药卫生—药品] R771[医药卫生—药学]